Giuseppe
Emeritus
[Source: PLoS ONE, full page: (LINK). Abstract, edited.]
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Supply of Neuraminidase Inhibitors Related to Reduced Influenza A (H1N1) Mortality during the 2009?2010 H1N1 Pandemic: An Ecological Study
Paula E. Miller<SUP>1</SUP><SUP>#</SUP>, Aksharananda Rambachan<SUP>1</SUP><SUP>#</SUP>, Roderick J. Hubbard<SUP>1</SUP>, Jiabai Li<SUP>1</SUP>, Alison E. Meyer<SUP>1</SUP>, Peter Stephens<SUP>2</SUP>, Anthony W. Mounts<SUP>3</SUP>, Melissa A. Rolfes<SUP>4</SUP><SUP>*</SUP>, Charles R. Penn<SUP>3</SUP>
<SUP></SUP>
1 Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America, 2 IMS Health, London, United Kingdom, 3 World Health Organization, Geneva, Switzerland, 4 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
Abstract
Background
The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality.
Methods
Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders.
Results
After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase).
Conclusion
While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.
Citation: Miller PE, Rambachan A, Hubbard RJ, Li J, Meyer AE, et al. (2012) Supply of Neuraminidase Inhibitors Related to Reduced Influenza A (H1N1) Mortality during the 2009?2010 H1N1 Pandemic: An Ecological Study. PLoS ONE 7(9): e43491. doi:10.1371/journal.pone.0043491
Editor: D. William Cameron, University of Ottawa, Canada
Received: April 30, 2012; Accepted: July 23, 2012; Published: September 11, 2012
Copyright: ? 2012 Miller et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported in part by National Science Foundation Grant # DMS-0354308. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.
Competing interests: Peter Stephens, one of the co-authors, is employed by IMS Health. IMS Health is paid by the pharmaceutical industry and governments around the world to collect, analyze and/or consult on patterns relating to the consumption of medicines, including the manufacturers of the two medicines described in this study. No payments to IMS Health or Peter Stephens were made for this analysis. None of the other authors have any potential conflicts of interest to report. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.
* E-mail: riede056@umn.edu
# These authors contributed equally to this work.
-Paula E. Miller<SUP>1</SUP><SUP>#</SUP>, Aksharananda Rambachan<SUP>1</SUP><SUP>#</SUP>, Roderick J. Hubbard<SUP>1</SUP>, Jiabai Li<SUP>1</SUP>, Alison E. Meyer<SUP>1</SUP>, Peter Stephens<SUP>2</SUP>, Anthony W. Mounts<SUP>3</SUP>, Melissa A. Rolfes<SUP>4</SUP><SUP>*</SUP>, Charles R. Penn<SUP>3</SUP>
<SUP></SUP>
1 Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America, 2 IMS Health, London, United Kingdom, 3 World Health Organization, Geneva, Switzerland, 4 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
Abstract
Background
The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality.
Methods
Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders.
Results
After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase).
Conclusion
While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.
Citation: Miller PE, Rambachan A, Hubbard RJ, Li J, Meyer AE, et al. (2012) Supply of Neuraminidase Inhibitors Related to Reduced Influenza A (H1N1) Mortality during the 2009?2010 H1N1 Pandemic: An Ecological Study. PLoS ONE 7(9): e43491. doi:10.1371/journal.pone.0043491
Editor: D. William Cameron, University of Ottawa, Canada
Received: April 30, 2012; Accepted: July 23, 2012; Published: September 11, 2012
Copyright: ? 2012 Miller et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported in part by National Science Foundation Grant # DMS-0354308. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.
Competing interests: Peter Stephens, one of the co-authors, is employed by IMS Health. IMS Health is paid by the pharmaceutical industry and governments around the world to collect, analyze and/or consult on patterns relating to the consumption of medicines, including the manufacturers of the two medicines described in this study. No payments to IMS Health or Peter Stephens were made for this analysis. None of the other authors have any potential conflicts of interest to report. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.
* E-mail: riede056@umn.edu
# These authors contributed equally to this work.
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